Ngaboyeka Gaylord, Mulume Armand, Lurhangire Emmanuel, Neven Anouk, Zigabe Lydia, Balolebwami Serge, Mwene-Batu Pacifique, Dramaix Michelle, Donnen Philippe, Bisimwa Ghislain
École Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo.
School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
BMC Public Health. 2025 Jan 20;25(1):229. doi: 10.1186/s12889-025-21301-w.
The studies on the use and performance of the Mid-Upper Arm Circumference for age (MUACZ) for the diagnosis of severe acute malnutrition (SAM) are still rare. Our study aimed to analyze the performance of MUACZ for diagnosis of SAM in South Kivu, eastern DR Congo.
We analyzed a database of children admitted from 1987 to 2008 for management of SAM in the east of the DRC. Anthropometric indicators (z-score) were calculated and classified according to the standards of the World Health Organization (WHO). To evaluate the performance of MUACZ using the combination of weight-for-height (WHZ) and Mid-Upper Arm Circumference (MUAC) as the reference, we calculated sensitivity, specificity, positive and negative predictive values (PPV and NPV) overall. Subsequently, we stratified the results by age category, presence or absence of stunting, and presence or absence of edema.
Of the 9969 children aged 6 to 59 months selected, 30.2% had nutritional edema, 70.1% had stunting. Of all cases of SAM (identified by at least one of the WHZ, MUAC, or MUACZ indicators), MUACZ alone identified 85% of them, surpassing other criteria such as MUAC (58%) and WHZ (45%). The MUACZ-WHZ combination identified 97%, surpassing the MUAC-WHZ combination (76%). In the presence of edema, MUACZ-WHZ identified 99%, while MUAC-WHZ identified only 72%. The proportions of SAM cases diagnosed by MUACZ increased according to age groups, with rates of 73% (6-11 months), 85% (12-23 months) and 91% (24-59 months). In the presence of stunting, the detection rates were 58% for MUAC alone, 44% for WHZ alone, 89% for MUACZ alone, 67% for the MUAC-WHZ combination, and 98% for the MUACZ-WHZ combination. MUACZ had a sensitivity of 80.7% (79.9-81.5), a specificity of 92.3% (91.8-92.8), a PPV of 71.5% (70.7-72.4) with a prior prevalence was 19,3% defined by the reference, and an NPV of 95.2% (94.8-95.7). Sensitivity increased in the presence of edema [90.1% (88.9-91.1)], stunting [84.7% (83.8-85.5)] and in children over 12 months [83.6% (82.2-84.9)].
The MUACZ was performing well in our region. In a context of high prevalence of stunting and kwashiorkor, MUACZ appears to be a more reliable indicator than MUAC alone. Moreover, the MUACZ-WHZ combination also seems to outperform the MUAC-WHZ combination. These results highlight the MUACZ potential, as well as its combination with WHZ, in enhancing screening of SAM in similar contexts.
关于年龄别上臂中部周长（MUACZ）用于诊断重度急性营养不良（SAM）的使用和性能的研究仍然很少。我们的研究旨在分析MUACZ在刚果民主共和国东部南基伍省诊断SAM的性能。
我们分析了1987年至2008年期间因SAM管理而入住刚果民主共和国东部的儿童数据库。根据世界卫生组织（WHO）的标准计算并分类人体测量指标（z评分）。为了以身高别体重（WHZ）和上臂中部周长（MUAC）的组合为参考评估MUACZ的性能，我们总体计算了敏感性、特异性、阳性和阴性预测值（PPV和NPV）。随后，我们按年龄类别、是否存在发育迟缓以及是否存在水肿对结果进行分层。
在选定的9969名6至59个月大的儿童中，30.2%有营养性水肿，70.1%有发育迟缓。在所有SAM病例（通过WHZ、MUAC或MUACZ指标中的至少一项确定）中，仅MUACZ就识别出其中的85%，超过了其他标准，如MUAC（58%）和WHZ(45%)。MUACZ-WHZ组合识别出97%，超过了MUAC-WHZ组合（76%）。在存在水肿的情况下，MUACZ-WHZ识别出99%，而MUAC-WHZ仅识别出72%。MUACZ诊断的SAM病例比例随年龄组增加，6至11个月为73%，12至23个月为85%，24至59个月为91%。在存在发育迟缓的情况下，单独MUAC的检出率为58%，单独WHZ为44%，单独MUACZ为89%，MUAC-WHZ组合为67%，MUACZ-WHZ组合为98%。MUACZ的敏感性为80.7%（79.9-81.5），特异性为92.3%（91,8-92.8），PPV为71.5%（70.7-72.4），参考定义的先前患病率为19.3%，NPV为95.2%（94.8-95.7）。在存在水肿[90.1%（88.9-91.1）]、发育迟缓[84.7%（83.8-85.5）]以及12个月以上儿童[83.6%（82.2-84.9）]时敏感性增加。
MUACZ在我们地区表现良好。在发育迟缓和夸希奥科病高流行的背景下，MUACZ似乎比单独的MUAC更可靠。此外，MUACZ-WHZ组合似乎也优于MUAC-WHZ组合。这些结果突出了MUACZ及其与WHZ组合在类似背景下加强SAM筛查方面的潜力。
